急性胆囊炎腹腔镜胆囊切除术的时机

Timing of laparoscopic cholecystectomy for acute cholecystitis

目的探讨急性胆囊炎腹腔镜胆囊切除术(LC)的可行性及手术时机。方法回顾分析了我院1991年9月～1998年7月5800例LC中386例急性胆囊炎患者(6.5 %)腹痛发作时间与手术操作难易程度及中转开腹率高低关系。结果发作48小时以内者197例 ,192例完成了LC手术操作 ,平均手术时间37分钟(15～70分钟) ,5例中转开腹(2.6%) ;发作2～6天者189例 ,19例中转开腹(10 %) ,170例成功完成了LC操作 ,平均手术时间54分钟(30～90分钟)。全部患者均痊愈出院 ,无严重并发症病例出现。结论急性胆囊炎发作48小时以内者完成LC操作较为简便 ,发作48小时以上者手术操作难度增大 。

Objective Whether laparoscopic cholecystectomy ( LC ) is practicable on patient with acute cholecystitis was further investigated .Methods LC had been performed during past 8 years in this hospital on 5 800 patients with cholecystitis , of which 386 ( 6.5 %) were acutely inflamed . The records of these were reviewed and analysed .Results Within 48 hours following the acute onset , LC was achieved on 192 out of 197 patients with mean operation time of 37 ( ranging 15-70 ) minutes and a 2.6 percent ( 5 cases ) conversion rate to open cholecystectomy ( OC ) .Beyond 48 hours after the attack ( ranging 48h-6days ) LC was completed on 170 out of 189 instances . The mean time for LC lasted 54 ( ranging 30-90 ) minutes with a rate of conversion up to 10 percent ( 19 cases ) . All recovered uneventfully .Conclusion LC is feasible and safe for acute cholecystitis especially when it is done around 48 hours after attack , ortherwise the operative risk and rate of conversion to OC will increase with time elapsed, since that relating undoubtedly with operator’s skill .